Biomedical Engineering Tissue Engineering

💉✨ “New Knee Without Surgery?” – The Truth Behind Germany’s Cartilage Repair Gel Since 2013, Germany has used a collagen-based gel (ChondroFiller/AMIC) to repair worn-out joint cartilage. 👉 It’s not just a quick injection—it requires a minimally invasive keyhole surgery where the gel acts as a scaffold for your body to regrow cartilage. 👉 Social media might call it a “brand-new miracle,” but it’s actually a decade-old technique. 👉 The real breakthroughs today? Injectable, biodegradable hydrogels now in clinical trials—designed to mimic natural cartilage and dissolve as new tissue grows. Yes—Germany has produced an injectable collagen-based gel, originally known as ChondroFiller, designed to help repair damaged joint cartilage in a minimally invasive way. Developed in collaboration with Fraunhofer Institute, it’s been available since 2013 and requires only a brief injection—not full-blown surgery. While posts on social media have recently hyped it as a brand-new breakthrough, the truth is more measured: the gel still involves minor procedures and carries the usual risks of allergic reactions. Current research continues to explore even more advanced, biodegradable cartilage-regenerating gels that mimic natural joint environments and dissolve as new tissue forms. These innovations are still experimental, with promising results in early trials—but they’re not yet ready for everyday clinical use. Would you try regenerative gels instead of joint replacement in the future? 🤔👇 #MedicalMyths #RegenerativeMedicine #CartilageRepair #JointHealth #Orthopedics #Biotech #FutureOfMedicine

Anterior cruciate ligament (ACL) tear is common in sports and accidents, and accounts for over 50% of all knee injuries. ACL reconstruction (ACLR) is commonly indicated to restore the knee stability, prevent anterior–posterior translation, and reduce the risk of developing post-traumatic osteoarthritis. However, the outcome of biological graft healing is not satisfactory with graft failure after ACLR. Tendon graft-to-bone tunnel healing and graft mid-substance remodeling are two key challenges of biological graft healing after ACLR. Mounting evidence supports excessive inflammation due to ACL injury and ACLR, and tendon graft-to-bone tunnel motion negatively influences these two key processes. To tackle the problem of biological graft healing, we believe that an inductive approach should be adopted, starting from the endpoint that we expected after ACLR, even though the results may not be achievable at present, followed by developing clinically practical strategies to achieve this ultimate goal. We believe that mineralization of tunnel graft and ligamentization of graft mid-substance to restore the ultrastructure and anatomy of the original ACL are the ultimate targets of ACLR. Hence, strategies that are osteoinductive, angiogenic, or anti-inflammatory should drive graft healing toward the targets. This paper reviews pre-clinical and clinical literature supporting this claim and the role of inflammation in negatively influencing graft healing. The practical considerations when developing a biological therapy to promote ACLR for future clinical translation are also discussed.

💡 This is not just an algorithm — it’s a mindset shift. 👺Every ACL is different. Every tibial morphology is unique ! So should be the surgical strategy. 🔬 Our latest work introduces the A+STRA Score — a personalized, scenario-based algorithm for guiding slope-correcting osteotomies in complex ACL cases. 📉 Posterior tibial slope (PTS) is a known risk factor for graft failure, but PTS alone is not enough. ✅ We propose an integrated approach combining slope measurements with clinical risk and limiting factors — because real patients don’t fit into single-variable models. An maybe we can start both « thinking outside of the notch » Bertrand Sonnery-Cottet and « outside of the joint » Philipp Schuster ! 🧠 Key messages: • PTS >12° ≠ automatic osteotomy. • Consider the entire clinical context: revision history (1-2-3 surgery ?), meniscus status Romain Seil Robert LaPrade , sATT David H. DEJOUR , tunnel placement, previous LET Etienne Cavaignac Steven Claes • Avoid slope correction in cases like recurvatum Alan Getgood , wrong tunnels Thomas Neri , or early infectio, deepMCL Nicolas BOUGUENNEC, PLC Sachin Tapasvi (or any reason that can explain acl rupture by itself !) • Address extra-articular deformity when >5° with biplanar planning. 👨⚕️ The A+STRA Score stratifies risk, balances pros & cons, and helps navigate ACL + SLOPE scenarios with patient-specific clarity. Huge thanks to KSSTA Journal and ESSKA - European Society of Sports Traumatology, Knee Surgery & Arthroscopy teams Sebastien Parratte Dr. Kristian Kley Michael Prof Dr. med. Hirschmann @ahmed mabrouk 📚 Now online: https://lnkd.in/dtC78dz4 #ACL #SportsMedicine #KneeSurgery #SlopeOsteotomy #Orthopedics #AplusSTRA #PTS #ACLReconstruction #LinkedInMed

1️⃣ What causes ACL reconstruction failure? It’s not always a surgical technique...often, it’s timing. 2️⃣ Returning too early—before regaining full endurance, proprioception, and strength which can re-injure the graft. That’s why sports-specific testing, like the Vail Sports Test, is essential. 3️⃣ Allograft vs. autograft: Allografts (donor tissue) can take up to 50% longer to heal, and fail in up to 45–50% of patients under 25 if used too soon. 4️⃣ Other causes include: ⚙️ Tunnel misplacement 🩹 Meniscus or ligament injuries (MCL, PLC) 📈 Increased posterior tibial slope Rehab right. Test readiness. Protect your graft. https://medilink.us/ts7i #ACLRecovery #SportsMedicine #Rehab

"Lateral extra-articular tenodesis in the young athlete: Can we reduce the risk of re-injury?" Ted Ganley, MD and colleagues from Children's Hospital of Philadelphia answer that question and provide a great summary of the literature on ACLR + LET in youth athletes. Pediatric and adolescent patients undergoing ACLR have a particularly high risk of graft rupture. Restoring rotatory stability post-ACLR is challenging, with many patients exhibiting residual rotatory laxity, which correlates with decreased functional outcomes and higher graft rupture rates. LET has been shown to reduce rotatory instability and decrease reinjury risk. https://lnkd.in/ezuuc-9X LET indications include: ‣ High-Grade Pivot Shift ‣ Generalized Ligamentous Laxity ‣ Age: Patients under 25 years old ‣ Gender: Females have a higher risk of ACL injuries ‣ Increased Posterior Tibial Slope ‣ Meniscus Root and Ramp injuries ‣ Segond Fracture ‣ Revision ACLR ‣ Participation in cutting sports or activities ‣ Participation in contact sports or activities ‣ Graft choice and surgical technique #kneeinjury #aclr #aclreconstruction #acltear #aclinjury #let #leap #kneesports #orthopedics University of Pennsylvania School of Medicine

German researchers have developed a bioactive injectable hydrogel that promotes the natural regrowth of damaged joint cartilage, offering a potential alternative to invasive surgery. This innovative gel is formulated with collagen, growth factors, and compounds that attract the body's own stem cells to the site of injury, creating a scaffold for the tissue to rebuild itself. This breakthrough in regenerative medicine could revolutionize treatment for millions suffering from arthritis, sports injuries, and joint degeneration, promising a future where a simple injection could restore mobility and eliminate the need for joint replacements.

FIFA announced this week that they are funding research investigating the links between the menstrual cycle and anterior cruciate ligament (ACL) injuries in women's football (soccer, for you yanks 😉 ⚽️) Women are, staggeringly, up to 8 (!!) times more likely to suffer from ACL tears than men and post-operative reoccurrences are also significantly higher. With this often being a potentially career-ending issue for athletes, it's high time we start to address it with science. So what are the potential reasons for this? 𝟭. 𝗔𝗻𝗮𝘁𝗼𝗺𝘆/𝗯𝗶𝗼𝗺𝗲𝗰𝗵𝗮𝗻𝗶𝗰𝘀 🦿 :  • Hip-to-knee angles: Women often have a slightly wider pelvis than men, which creates a larger “Q-angle” between the hip and knee, which can lead to more inward force on the knee when jumping, landing, or cutting. [1]  • Joint laxity: Some research has demonstrated that females tend to have ‘looser’ ligaments, reducing stability. [2]  • Smaller ACLs: On average, even when accounting for differences in body size/weight, females have smaller ACLs by cross section, length, and volume, relative to males. Which may be why they are more susceptible to tearing under stress. [3, 4, 5] 𝟮. 𝗛𝗼𝗿𝗺𝗼𝗻𝗲𝘀 🩸 :  • Higher Oestrogen concentrations can lead to decreased collagen synthesis and crosslinking in ligaments, resulting in reduced tensile strength and increased laxity. [6]  • Altered Neuromuscular Control: Oestrogen may influence neuromuscular coordination, potentially affecting joint stability during dynamic movements. 𝟯. 𝗧𝗿𝗮𝗶𝗻𝗶𝗻𝗴 𝗮𝗻𝗱 𝗰𝗼𝗻𝗱𝗶𝘁𝗶𝗼𝗻𝗶𝗻𝗴 🏋🏿♂️ 🏃🏻♀️:  • Footwear & Equipment: Most football boots are designed for male foot shapes, increasing injury risk for women due to poor fit and altered biomechanics. [7]  • Training Disparities: Many injury prevention programs are developed from male athlete data and lack female-specific neuromuscular focus. Female athletes are also less likely to receive structured strength and conditioning support, especially at youth and amateur levels. [8] 𝟰. 𝗚𝗲𝗻𝗲𝘁𝗶𝗰𝘀 🧬 :  • Collagen gene variants (e.g. COL5A1, COL1A1) are linked to increased ACL injury susceptibility, particularly in women. [9] Link to article: https://lnkd.in/ephDUPwu References: 1. https://lnkd.in/ee4ffnjR 2. https://lnkd.in/eST6cuWb 3. https://lnkd.in/e74_Qi87 4. https://lnkd.in/eq3BnkNy 5. https://lnkd.in/equnPCqX? 6. https://lnkd.in/ekZz_7We 7. https://lnkd.in/eQiSAiRf 8. https://lnkd.in/ee4ffnjR? 9. https://lnkd.in/eeg-x7kD #womenshealth #injuryprevention #genetics #ACL #fifa #sportstech

“Doc, I think I tore my rotary cup.” If you work in orthopedics, you have likely heard something like this before. The anatomic term is the Rotator Cuff–but what actually is the rotator cuff? How is a cuff tear repaired? I will share one way that I repaired a rotator cuff tear using many strong tape sutures. The rotator cuff is made of 4 separate tendons that attach to the top of the humerus or arm bone. These four tendons and their respective muscles are often remembered by students with the acronym SITS: supraspinatus, infraspinatus, teres minor, and subscapularis tendons. There are two main types of rotator cuff tears: degenerative and acute tears. We know from Dr. Yamaguchi’s JBJS study from 2006 (and many others) that rotator cuff disease correlates with age–these tears are like the wear and tear of your favorite pair of jeans because you’ve worn them out. Both conservative and surgical treatment can be an option for degenerative tears. The other type of tear is an acute or sudden tear, usually from an injury or accident. Young patients can often have acute tears from falls, sports, or possibly work activities. These are very different than degenerative tears. Research by Gutman et al (JSES 2021) showed that early repair of these acute tears optimizes outcomes. Tears like we see in this patient can be challenging to repair. This tear was in a patient under age 50 that is very active. This tear occurred acutely. Repair was recommended. The footprint on the greater tuberosity was gently decorticated with the shaver to encourage bone-tendon healing. I prefer to use a four-anchor double row repair for tears of this size using the Stryker AlphaVent Knotless anchors. The medial vented anchors were double-loaded to allow for force distribution for the sutures passed through the rotator cuff tissue. The double-row construct also optimizes footprint compression. Key for success: two passing-loop sutures were secured in luggage tag fashion to augment the repair and one eyelet suture was also passed to enhance anterior compression. These additional sutures prevent “dog-ears” and offer additional compression of the tendon to the bone. A 2020 study published in AJSM by Urch et al (including Dr. Thay Lee) analyzed the biomechanics of the additional luggage tag sutures; their results demonstrated improved contact pressure of the rotator cuff tissue on the bony footprint in the specimens that had the additional luggage tag sutures. The patient was started on a passive-only gentle PT program for the 1st six weeks, with further focus on active motion and strengthening to follow with the subsequent phases of PT. The residents and fellows at the Orlando Health Jewett Orthopedic Institute have frequent opportunities to see arthroscopic management of tears like these.

Why do I prefer #quadriceps tendon autograft for #ACL reconstruction? The science tells the story. A retrospective review of my ACL Outcomes Database revealed that my quadriceps tendon autografts measured 10.5 mm diameter compared to my hamstring grafts averaging 8.0 mm diameter. This diagram illustrates one of the key mechanical advantages: a 72.2% increase in bending resistance due to the larger graft diameter (10.5mm vs 8.0mm hamstring). In medicine, we follow the data - and the structural superiority of the quad tendon is clear. This month marks 10 years since I transitioned from hamstring to quadriceps tendon autograft in January 2015. A decade of clinical experience and outcomes data continues to validate this decision. When biomechanical advantage translates to clinical success, you stick with it. #laudthequad Steamboat Orthopaedic & Spine Institute | Steamboat Surgery Center | American Orthopaedic Society for Sports Medicine | American Academy of Orthopaedic Surgeons (AAOS) | #ACLreconstruction | #SportsOrthopedics | #SurgicalTechnique #EvidenceBasedMedicine

Margin convergence sutures One of the keys to success in #rotatorcuff repair is a tension-free construct. A common failure mode is cutting the suture through the tendon. We can prevent this by using the technique of margin convergence sutures, which was popularized by Stephen S. Burkhart twenty years ago. The principles he described are still valid and often forgotten, so it is good to recall them (https://lnkd.in/eRseeFdJ). Margin convergence sutures allow us to benefit from the good anterior-to-posterior mobility of the rotator cuff tear margins while also acting as rip-stop stitches. In the video you can see how subscap reapir and 4 margin convergence sutures dramatically reduced the size of this massive tear and allowed us to perform a simple #transosseous repair. The result was a tension-free construct and an excellently healed patient with full shoulder function today.